羟考酮联合奈福泮对全髋关节置换术患者的术后镇痛效果

Efficacy of oxycodone combined with nefopam for postoperative analgesia after total hip replacement surgery

目的观察羟考酮复合奈福泮用于全髋关节置换手术的术后镇痛效果。方法选择全身麻醉下全髋关节置换手术ASAⅠ或Ⅱ级患者50例,随机分为对照组和试验组,每组25例。两组麻醉诱导和维持方法相同,手术结束前30 min,均给予镇痛负荷剂量的舒芬太尼5μg,然后开启镇痛泵。对照组配方为吗啡1 mg·mL^(-1),试验组配方为羟考酮0.5 mg·mL^(-1)+奈福泮1 mg·mL^(-1),背景剂量2 mL·h^(-1),追加剂量每次0.5 mL,锁时15 min。记录两组术后48 h内镇痛效果、镇痛药用量、不良反应发生情况等。结果术后3、6、12、24、36 h,试验组疼痛视觉模拟量表(VAS)评分均低于对照组(P<0.05或P<0.01),对应时间点的镇痛药用量也减少(P<0.01)。术后48 h内,试验组呼吸抑制、恶心呕吐、嗜睡及皮肤瘙痒发生率均低于对照组(P<0.05)。结论羟考酮联合奈福泮用于全髋关节置换术后镇痛效果好、不良反应较少。

AIM To observe the effects of oxycodone combined with nefopam for postoperative analgesia after total hip replacement surgery. METHODS Fifty patients（ASA Ⅰor Ⅱ） scheduled for total hip replacement under general anesthesia were randomly divided into control group and trial group（ n = 25 in each）. Thirty minutes before the end of operation, sufentanil 5 μg was given and the analgesia pump was opened. In the control group, the patients received morphine 1 mg·m L^-1. The patients in the trial group received oxycodone0.5 mg·m L^-1＋ nefopam 1 mg·m L^-1. The back ground dose was 2 m L·h^-1 and bolus dose was 0.5 m L per time.The lock time was 15 min. The analgesic effect, analgesic consumption and adverse reactions in 48 h after operation were recorded. RESULTS The visual analogue scale（VAS） scores and the analgesic consumption at3, 6, 12, 24 and 36 h after operation were significantly lower in the trial group compared with those in the control group（P〈0.05 or P〈0.01）. Incidence of respiratory depression, nausea and vomiting, drowsiness and pruritus were significantly lower in the trial group compared with those in the control group in 48 h after the operation（ P〈0.05）. CONCLUSION The combination of oxycodone and nefopam for postoperative analgesia after total hip replacement surgery can provide more effective analgesia with fewer adverse reactions.